Field of the Invention
The present invention relates to a method for marking a tubular organ that is present inside a subject. In particular, the present invention is a method for simultaneously making markings for a procedure in substantially the same positions on the interior and exterior of a tubular organ. The markings are made by way of a therapeutic tool channel of an endoscope that is inserted through a natural orifice of the subject.
Description of the Related Art
Various techniques have been conventionally used to make markings for surgery on a tubular organ.
For example, when the interior of a tubular organ is observed under an endoscope and a lesion is found, a marking is made so as to surround the lesion. In other words, a marking device is pressed against a desired position on the periphery of the lesion. The area is then pressed outward while performing cauterization. At the same time, a similar marking is made on the exterior of the tubular organ in the area that bulges as a result of being pressed. This operation is performed repeatedly in a plurality of locations so as to surround the lesion. As a result, a plurality of markings that surround the lesion can be made on the interior and exterior wall portions of the tubular organ. Therefore, the marking positions on the exterior of the tubular organ provide positional information of the lesion that has been visually confirmed on the luminal-side wall of the tubular organ. For example, a procedure, such as excision along the positions on the organ, is performed based on the positional information.
However, several issues that have yet to be improved in the above-described marking method have been noted. One issue is that, when the markings are made on the interior and exterior of the tubular organ (referring to the interior and the exterior with the organ wall therebetween), first, the inner wall (mucosal wall) is marked. Then, the bulging area is marked. In other words, there is a time lag between the interior and the exterior. Therefore, the amount of time required for marking is an issue. In addition, the organ is pressed from the inner side by a tool and made to bulge. The marking position is visually estimated from the shape of the hump shape on the exterior caused by the bulge. Therefore, an issue has been noted in that the accuracy of the marking position on the outer side decreases. This issue is not only caused by the visual estimation. This issue is also often caused by the layers within the organ wall shifting as a result of the organ wall being pressed. The mucosal membrane and the muscle layer are loosely fixed together by a submucosal layer. Therefore, when the inner wall of the organ is pressed, the mucosal layer and the muscle layer become released from the fixed state (i.e., shift). The position on the bulging muscle layer is shifted from the intended marking position. As a result, a positional misalignment occurs between the position of the marking made on the exterior of the organ and the intended marking position.
Furthermore, a plurality of operators (doctors and the like) are required to work in cooperation to mark the interior and exterior of the tubular organ. When the timings do not match among the operators, the amount of time required for marking increases. This results in greater burden placed on the body of the patient.
Specific techniques for making such markings are described in patent literature. For example, WO08/0265689 discloses, as one example, marking the periphery of a lesion at a predetermined interval using a high-frequency knife. The high-frequency knife has a needle-shaped tip. In addition, JP-A-2006-326157 also discloses forming a hole, or in other words, a marking in a portion of the mucosal layer near a lesion using a needle-shaped high-frequency knife. The hole is formed as an incision for circumferential incision.